在老年人甲状腺功能障碍的诊断和管理方面的考虑
Sina Jasim1, Maria Papaleontiou2,3
1Division of Endocrinology, Metabolism and Lipid Research, Department of Medicine, Washington University, Saint Louis, Missouri, USA.
概括
老年人明显的甲状腺功能障碍需要治疗. 亚临床甲状腺功能低下症的TSH为7.0-9.9mIU/L或更高,以及亚临床甲状腺功能过高症的TSH<0.1mIU/L,需要考虑治疗.
科学领域:
- 内分泌学 在内分泌学.
- 老年病的医生 老年病的医生
- 内部医学 内部医学
背景情况:
- 甲状腺功能障碍在老年人中很普遍,这带来了独特的诊断和管理挑战.
- 与年龄相关的生理变化可能会使甲状腺功能评估复杂化.
- 老年人经常有并发症和多药,需要仔细考虑治疗.
研究的目的:
- 审查有关老年人甲状腺功能低下症和甲状腺功能过强症的诊断和管理的当前数据.
- 为了突出这一人口群体的特殊考虑.
- 为优化甲状腺激素管理提供基于证据的建议.
主要方法:
- 发表文学作品的叙述性回顾.
- 从2000年1月到2024年12月,对PubMed和Ovid MEDLINE数据库进行了全面的搜索.
- 在英语中包含相关文章.
主要成果:
- 过度的甲状腺功能低下症和甲状腺功能过高症需要由于心血管风险而接受治疗.
- 患有TSH 7.0-9.9 mIU/L或TSH ≥10 mIU/L的亚临床甲状腺功能低下症可能会受益于对levothyroxine的考虑.
- 亚临床甲状腺功能障碍症 (TSH <0.1 mIU/L) 与心血管风险增加和骨质损失有关,需要治疗.
- 在亚临床甲状腺功能低下症的试验中,levothyroxine没有改善症状.
- 由于不良事件,应避免甲状腺激素的过量和不足的替代.
- 低剂量甲基马是一种可行的替代放射性治疗老年人甲状腺功能障碍的替代品.
结论:
- 个性化的方法对于管理老年人甲状腺功能障碍至关重要.
- 考虑与年龄相关的变化,并发症和多药.
- 维持类甲状腺症是预防不良事件的关键.
相关概念视频
01:20Synthesis and Regulation of Thyroid Hormones
4.3K
Low blood levels of the thyroid hormones — triiodothyronine (T3) and thyroxine (T4) — signal the hypothalamus to release the thyrotropin-releasing hormone (TRH). TRH then reaches the pituitary gland and stimulates the release of thyroid-stimulating hormone(TSH) into the bloodstream.
Upon reaching the thyroid gland, TSH stimulates the follicular cells' active uptake of iodide ions from the blood. The ions diffuse to the apical surface of the cells and are oxidized to iodine. The...
Upon reaching the thyroid gland, TSH stimulates the follicular cells' active uptake of iodide ions from the blood. The ions diffuse to the apical surface of the cells and are oxidized to iodine. The...
4.3K
01:18Functions of Thyroid Hormones
2.6K
The thyroid hormone (TH) plays a pivotal role in the intricate orchestration of physiological processes, exerting profound effects on development, metabolism, and homeostasis throughout different life stages.
TH is indispensable for the normal development and maturation of the skeletal, muscular, and nervous systems during fetal and childhood growth. It facilitates bone mineral turnover and regulates protein synthesis in developing tissues, contributing significantly to overall growth and...
TH is indispensable for the normal development and maturation of the skeletal, muscular, and nervous systems during fetal and childhood growth. It facilitates bone mineral turnover and regulates protein synthesis in developing tissues, contributing significantly to overall growth and...
2.6K
01:23The Thyroid Gland
3.7K
The thyroid gland is a small, butterfly-shaped gland located in the neck and covers the anterior surface of the trachea. The gland has two lateral lobes connected by a thin tissue mass called the isthmus. Internally, each lobe comprises many small spherical structures known as thyroid follicles, surrounded by a network of blood vessels.
The follicles have a central cavity lined by simple cuboidal to squamous epithelial cells called follicular cells. These cells produce the glycoprotein...
The follicles have a central cavity lined by simple cuboidal to squamous epithelial cells called follicular cells. These cells produce the glycoprotein...
3.7K
01:29Bone Disorders
3.4K
Aging and its effect on bone remodeling is the most common cause of bone disorders. In young and healthy people, bone deposition and resorption happen at an equal rate to maintain optimal bone health.
Bone deposition is also affected by the levels of sex hormones like estrogen and testosterone that promote osteoblast activity and bone matrix synthesis. When the level of these hormones decreases due to aging, it causes a reduction in bone deposition. As a result, bone resorption by osteoclasts...
Bone deposition is also affected by the levels of sex hormones like estrogen and testosterone that promote osteoblast activity and bone matrix synthesis. When the level of these hormones decreases due to aging, it causes a reduction in bone deposition. As a result, bone resorption by osteoclasts...
3.4K
01:15Diabetes: Management and Pharmacotherapy
245
The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
245
01:28Menopause
146
Menopause, a natural biological process marking the end of a woman's fertility, typically occurs between the fifth and sixth decade of life. This phase is characterized by the exhaustion of the ovarian follicle pool, leading to less responsive ovaries despite the high levels of Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH). The consequential decrease in estrogen production results in symptoms like hot flashes, heavy sweating, headaches, hair loss, muscle pains, vaginal...
146